急性骨髄性白血病 AML - jspho.jp

1 45 I CQ 1 AML CQ 2 AML CQ 3 AML CQ 4 AML CQ 5 AML CQ 6 APL CQ 7 Down AML II AML Acute Myeloid Leukemia APL Acute Promyelocytic Leukemia FAB French American British WHO World Health Organization ATRA All trans Retinoic Acid DIC Disseminated Intravascular Coagulation CALGB The Cancer and Leukemia Group B SCT Stem Cell Transplantation EFS Event Free Survival AML46 AML III AML AML Down AML APL AML III A 1 AML FAB 1 WHO 2 1 AML 10 15 Down 21 AML Down 1CQ 1 FAB M0 MPO MPO CD13 and/or CD33 M1 3 MPO M2 M3 faggot Auer DIC M3v M3 M4 NEC 30 20 5.

2 000/ L M4Eo NEC 5 M5 NEC 80 M5a 80 M5b 80 M6 ANC 50 NEC 30 M7 PPO CD41 and/or CD42 Down NEC ; nonerythroid cells, bone marrow cells excluding erythroblastsANC ; all nucleated bone marrow cellCQ1 47 1 AML 10 APL ATRA 1 FAB M3 2 WHO 1 1 AML t 8 ; 21 q22 ; q22 RUNX1 RUNX1T1 CBFA/ETO AML inv 16 p13q22 t 16 ; 16 p13 ; q22 CBFB MYH11 AML t 15 ; 17 q22 ; q12 PML RARA APL t 9 ; 11 p22 ; q23 MLLT3 MLL AML t 6 ; 9 p23 ; q34 DEK NUP214 AML inv 3 t 3 ; 3 q21 ; RPN1 EVI1 AML t 1 ; 22 p12 ; q13 RBM15 MKL1 AML megakaryoblastic NPM1 AML CEBPA AML2 AML3 4 AML AML AML AML 5 6 Down Down 7 AML III A 2 AML t 8 ; 21 inv 16 t 16.

3 16 48 AMLmonosomy 5 monosomy 7 5q 2 5 2,4 6 3 SCT 7,8 FMS like tyrosine kinase 3 internal tandem duplication FLT3 ITD 9,10 3 6,7 11q23 11 t 6 ; 9 MLL c Kit 2,7 3 1 2 Monosomy 7, 5q , t 16 ; 21 p11 ; q22 Ph1 FLT3 ITD SCT 1 t 8 ; 21 inv 16 t 16 ; 16 CQ2 49 AML de novo AML I A 1 AML 100 mg/m2 7 45 mg/m2 3 7 and 3 12 80 90 8,13 15 thioguanine 16 19 ANLL91 AML99 90 16,20 2CQ50 AML AML III A 1 2 2 4 4 21 24 AML CALGB 25 t 8.

4 21 3 4 1 26 AML 21 23 AML99 CCLSG 9805 EFS 50 60 60 70 8,27,28 LAME89/91 29,30 BFM AML 31 3CQ CQ4 51 AML SCT III B SCT 3 5 47 57 72 87 8,24 SCT SCT 32,33 HLA HLA HLA 34 Eurocord 95 AML HLA 35 2002 36 4CQ52 AML AML SCT III B AML 5 SCT 23 33 SCT 0 37,38 SCT 58 62 5 39 41 68 34 45 58 34,42 50 55 34.

5 35 5 5CQ CQ6 53 APL II A APL DIC APL oncologic emergency 43,44 APL key drug ATRA 2 APL 95 DIC APL 45,46 ATRA ATRA APL 75 EFS 85 47 49 AML99 M3 96 4 EFS 90 4 50 6CQ54 AML Down AML III A BFM Down AML Down Down Down AML 3 EFS 75 90 51 53 1987 97 AT DS 2000 04 AML99 Down Down AML 3 EFS 80 85 54.

6 55 7CQ 55 IV CQ1 AML CQ2 AML CQ3 AML Medline 4 2007 2010 aml & treatment & childhood 128 12 5 14 medline 3 21 CQ4 AML Medline 4 2007 2010 aml & sct 121 5 7 medline 0 7 CQ5 AML CQ Medline 10 2001 2010 aml & relapsed & childhood 51 aml & recurrence & childhood 57 8 medline 2 CQ6 APL Medline 10 2001 2010 acute promyelocytic leukemia & all child & treatment 306 5 3 8 CQ7 Down AML Medline 4 2007 2010 aml & down syndrome 43 12 9 2 medline 1 5 56 AML 1 Arber DA, et al : Acute myeloid leukemia with recurrent geneteic abnormalities.

7 WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues, 4th ed, IARC, 2007, p109 148. 2 Meshinchi S, Arceci RJ : Prognostic factors and risk based therapy in pediatric acute myeloid leukemia. Oncologist 12 : 341 355, 2007. 3 Grimwade D, Walker H, Oliver F, et al : The importance of diagnostic cytogenetics on outcome in AML : analysis of 1,612 patients entered into the MRC AML 10 trial. Blood 92 : 2322 2333, 1998. IV 4 Wheatley K, Burnett AK, Goldstone AH, et al : A simple, robust, validated and highly predictive index for the determination of risk directed therapy in acute myeloid leukaemia derived from the MRC AML 10 trial. Br J Haematol 107 : 69 79, 1999. IV 5 Creutzig U, Zimmermann M , Ritter J, et al : Definition of a standard risk group in children with AML.

8 Br J Haematol 104 : 630 639, 1999. 6 23 : 257 265, 2009. 7 Kaspers GJ, Zwaan CM : Pediatric acute myeloid leukemia : towards high quality cure of all patients. Haematologica 92 : 1519 1532, 2007. 8 Tsukimoto I, Tawa A, Horibe K, et al : Risk stratified therapy and the intensive use of cytarabine improves the outcome in childhood acute myeloid leukemia : the AML99 trial from the Japanese Childhood AML Cooperative Study Group. J Clin Oncol 27 : 4007 4013, 2009. III 9 Meshinchi S, Alonzo TA, Stirewalt DL, et al : Clinical implications of FLT3 mutations in pediatric AML. Blood 108 : 3654 3661, 2006. IV 10 Shimada A, Taki T, Tabuchi K, et al : Tandem duplications of MLL and FLT3 are correlated with poor prognoses in pediatric acute myeloid leukemia : a study of the Japanese Childhood AML Cooperative Study Group.

9 Pediatr Blood Cancer 50 : 264 269, 2008. IV 11 Balgobind BV, Raimondi SC, Harbott J, et al : Novel prognostic subgroups in childhood 11q23/MLL rearranged acute myeloid leukemia : results of an international retrospective study. Blood 114 : 2489 2496, 2009. 12 Vormoor J, Boos J, Stahnke K, et al : Therapy of childhood acute myelogenous leukemias. Ann Hematol 73 : 11 24, 1996. 13 Kaspers GJ, Creutzig U : Pediatric acute myeloid leukemia : international progress and future directions. Leukemia 19 : 2025 2029, 2005. 14 Stevens RF, Hann IM, Wheatley K, et al : Marked improvements in outcome with chemotherapy alone in paediatric acute myeloid leukemia : results of the United Kingdom Medical Research Council s 10th AML trial. Br J Haematol 101 : 130 140, 1998. II 15 Creutzig U, Zimmermann M , Lehrnbecher T, et al : Less toxicity by optimizing chemotherapy, but not by addition of granulocyte colony stimulating factor in children and adolescents with acute myeloid leukemia : results of AML BFM98.

10 J Clin Oncol 24 : 4499 4506, 2006. II 16 Hann IM, Stevens RF, Goldstone AH, et al : Randomized comparison of DAT versus ADE as induction chemotherapy in children and younger adults with acute myeloid leukemia. Results of the Medical Research Council s 10th AML trial MRC AML 10 . Blood 89 : 2311 2318, 1997. II 17 Creutzig U, Ritter J, Zimmermann M, et al : Idarubicin improves blast cell clearance during induction therapy in children with AML : results of study AML BFM93. Leukemia 15 : 348 354, 2001. II 18 O Brien TA, Russell SJ, Vowels MR, et al : Results of consecutive trials for children newly diagnosed with acute myeloid leukemia from the Australian and New Zealand Children s Cancer Study Group. Blood 100 : 2708 2716, 2002. III 19 Lange BJ, Smith FO, Feusner J, et al : Outcomes in CCG 2961, a Children s Oncology Group Phase 3 Trial for untreated pediatric acute myeloid leukemia : a report fron the Children s Oncology Group.